Vermont's Universal Healthcare Promise: Who Pays the Bill?

Stephanie Mack, candidate for Vermont House in Chittenden-24, raises questions about how Vermont would fund universal primary care while addressing the state's already high healthcare costs.

As Vermont politicians debate universal primary care and single-payer healthcare, the cost of delivering those promises remains uncertain.

On October 22, Vermont House Health Care Committee Chair Alyssa Black made a revealing statement during an interview on WVMT radio. Discussing the obstacles to establishing a statewide single-payer healthcare system, Black said, "I actually don't believe we can do single payer."

Later that same day, Senator Bernie Sanders appeared alongside Democratic gubernatorial candidate Amanda Janoo in Winooski, promoting her proposal to provide universal primary care at no charge to patients. Janoo described the program as a first step toward a comprehensive, publicly funded healthcare system.

The two developments raise an important question about Vermont's healthcare ambitions: What exactly is being promised, and how will Vermonters pay for it?

Universal Primary Care Is Not Single-Payer Healthcare

Universal primary care promises free access to routine medical services, including checkups, preventive care, and treatment of common illnesses. It would not cover hospitalization, surgery, or other specialized medical treatment.

Single-payer healthcare would be provided under the coverage of one publicly administered financing system for a greater range of medical services.

Black explained that Vermont cannot combine a number of existing insurance arrangements because Medicare and federally regulated self-funded employer plans operate largely outside state insurance authority.

While these restrictions complicate any comprehensive single-payer proposal, they don't prevent Vermont from developing a universal primary-care program.

Vermont's Act 173, signed in June, already establishes legislative intent to pursue universal primary care. However, the law does not create an operational program or provide any form of financing it.

Can Vermont Afford the Promise?

Janoo has estimated that her universal primary-care proposal would cost approximately $320 million annually. She believes it can be paid for by increasing income taxes on higher earners, citing proposals developed by Fair Share for Vermont.

The largest of those proposals estimates $344 million in annual revenue through additional income taxes on earnings above $250,000 and $500,000. Janoo also predicts that better preventive care could eventually save Vermont as much as $300 million annually by reducing expensive hospitalizations and emergency medical treatment.

The estimated tax revenue depends on future taxable income and the compliance of a relatively small group of high-earning taxpayers whose income can fluctuate substantially. Higher tax rates would immediately begin to shape decisions about investment, income attribution, and residency status.

The program's complete costs are speculative. Vermont would need to recruit more primary-care professionals to serve additional patients, and officials would have to determine how the new public financing would interact with payments already made by Medicare, Medicaid, and private insurers.

Better primary care might improve health and prevent some expensive medical treatment, but research has yet to show that increased primary-care reduces total healthcare spending. Even when savings occur, they may benefit federal programs or private insurers rather than Vermont's state budget.

Taxing higher incomes could generate a burst of substantial revenue, but there is no guarantee that it will remain sustainable, much less increase over time to cover the escalating costs of medical treatment and hospital services, insurance premiums, or the total cost of Vermont's healthcare system..

What About Vermont's Existing Healthcare Costs?

Vermont already faces an extraordinary affordability problem. According to the Kaiser Family Foundation, the average monthly premium before subsidies for a benchmark Silver health-insurance plan covering a 40-year-old was $1,299 in Vermont in 2026—more than three times the $401 average in neighboring New Hampshire.

The central question is not simply whether Vermont should make primary care more accessible. It is whether the state can deliver that promise with a sustainable financing plan while making meaningful progress on the healthcare costs Vermonters are already struggling to afford.

Before any promises are made Vermonters deserve a complete accounting of what any new program would cover, how much it would cost, which existing payments it would replace, and how its financial results will be measured.

Sources: WVMT Morning Drive, October 22, 2026; VTDigger reporting on Sanders and Janoo, October 22, 2026; Vermont Public reporting on universal primary care, October 14, 2026; KFF 2026 marketplace premium data; Vermont Act 173; Green Mountain Care Board healthcare-cost presentation, October 2026.